Housing and Mental Health Support for Exposure to Gun Violence

(TRUE HAVEN Trial)

Recruiting at 3 trial locations

Overseen By Emily Wang, MD, MAS

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Yale University

Disqualifiers: Plans to leave area

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

61770 Participants Needed

Trial Summary

What is the purpose of this trial?

The overall objective of this study is to implement and test a strengths-based, community-driven intervention to reduce gun violence by (1) improving housing stability through providing financial assistance coupled with comprehensive financial education for the re-entry population as well as their family members, and (2) fostering greater support for mental health by training a trusted network of community members in trauma-informed counseling.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment TRUE HAVEN for reducing gun violence and improving mental health?

Research on supportive housing, similar to TRUE HAVEN, shows it can improve mental health and overall health by providing stable housing and reducing psychological distress. This suggests that TRUE HAVEN's approach of combining housing support with trauma-informed care may effectively reduce gun violence and improve well-being in affected communities. ^{1 2 3 4 5}

Is the TRUE HAVEN program safe for participants?

The TRUE HAVEN program focuses on providing stable housing and support to reduce gun violence, but there is no specific safety data available from the research articles. The program involves financial education, trauma-informed counseling, and policy changes, which are generally considered safe interventions. ^{1 2 6 7 8}

How does the TRUE HAVEN treatment differ from other treatments for exposure to gun violence?

TRUE HAVEN is unique because it combines stable housing support, financial education, trauma-informed counseling, and policy changes to address structural racism, aiming to reduce gun violence by improving the stability and well-being of those affected by incarceration. ^{1 2 7 9 10}

Research Team

Emily Wang, MD, MAS

Principal Investigator

Yale University

Eligibility Criteria

This trial is for residents in certain neighborhoods who have experienced gun violence. It's open to those re-entering society and their families, aiming to improve housing stability with financial aid and education. Mental health support is also provided through trained community counselors.

Inclusion Criteria

Family member currently incarcerated or person returning from prison within the last 12 months

Live in one of the six neighborhoods with highest rates of gun violence in New Haven, Connecticut

Exclusion Criteria

Plans to leave the study area within 1 year

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive housing support and mental wellness training for 6 months

6 months

Follow-up

Participants are monitored for changes in self-efficacy, gun violence rates, social cohesion, perceived health, and financial security

30 months

Treatment Details

Interventions

• Name
• TRUE HAVEN

Trial Overview The 'TRUE HAVEN' intervention is being tested, which combines financial assistance for housing with educational support, as well as mental health services via a network of community members trained in trauma-informed counseling.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

The two components in the intervention arm of TRUE HAVEN are: housing support for recently incarcerated people as well as family members of currently incarcerated people, and mental wellness training for neighborhood residents to participate in trauma-informed care training sessions.

Group II: Control Active Control 1 Intervention

TRUE HAVEN is already approved in United States for the following indications:

Approved in United States as TRUE HAVEN for:

• Gun violence prevention
• Community resilience building

Who Is Running the Clinical Trial?

Yale University

Lead Sponsor

Trials

1,963

Recruited

3,046,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Findings from Research

The TRUE HAVEN study is designed to reduce community gun violence in New Haven by providing stable housing and financial education to individuals affected by incarceration, with interventions implemented in six high-violence neighborhoods over staggered six-month periods.

The study incorporates trauma-informed counseling and policy changes to combat structural racism, aiming to create a comprehensive approach that not only addresses immediate needs but also fosters long-term community stability and well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN): A strengths-based and community-driven stepped-wedge intervention to reduce gun violence. Tong, G., Spell, VT., Horton, N., et al.[2023]

The TRUE HAVEN study is designed to reduce community gun violence in New Haven, Connecticut, by providing stable housing and financial education to individuals affected by incarceration, with a focus on neighborhoods with high gun violence rates.

This multi-level intervention includes trauma-informed counseling and policy changes to combat structural racism, aiming to foster community stability and well-being, with the primary outcome being the neighborhood rate of gun violence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence. Tong, G., Spell, VT., Horton, N., et al.[2023]

In a study of 237 participants experiencing homelessness and serious mental illness, supportive housing was linked to significantly better overall health outcomes, with participants showing three times the odds of reporting good to excellent health after 6 months.

Supportive housing also contributed to reduced psychological distress over time, highlighting its effectiveness as a health intervention in improving mental health and quality of life for individuals in diverse backgrounds.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population. Crisanti, AS., Duran, D., Greene, RN., et al.[2022]

Supportive housing, particularly the 'housing first' model, is the leading approach in the U.S. for helping chronically homeless individuals achieve housing stability and improved health, but the implementation of this model varies significantly across programs.

Qualitative interviews in Chicago revealed six distinct types of supportive housing based on housing configuration and service models, highlighting the need for comparative effectiveness research to determine which combinations of components yield the best health outcomes for different homeless subpopulations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying variability in permanent supportive housing: A comparative effectiveness approach to measuring health outcomes. Dickson-Gomez, J., Quinn, K., Bendixen, A., et al.[2022]

Permanent supportive housing programs with case management support significantly help homeless individuals with mental illness, as most participants remained housed for at least one year compared to those in control groups.

Despite these positive outcomes, the review identified significant limitations in the studies, such as biases and inconsistent definitions of housing programs, which hinder the ability to draw strong conclusions for policy-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes. Benston, EA.[2022]

The Project Safe Neighborhoods: Dallas initiative did not lead to a reduction in violent crime rates in the target areas, which remained higher than non-target areas, and even showed a non-significant increase after its launch in April 2018.

Rates of patients presenting with firearm and assaultive injuries nearly doubled within two years of the initiative, indicating that the program may have been ineffective in reducing violence and that offenders might have relocated to avoid increased law enforcement scrutiny.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safer neighborhoods? Violent crime and trauma volume pre/post targeted police interventions in Dallas, Texas. Roden-Foreman, JW., Pettigrew, M., Edmundson, PM., et al.[2023]

Only a small percentage of individuals with mental illness are at risk for extreme violence, and they contribute to a minor fraction of gun-related homicides, highlighting the complexity of gun violence as a public health issue.

The authors recommend that Connecticut physicians advocate for securing guns in homes with children and consider voluntary removal of firearms from homes with individuals at risk for violence or with untreated major mental illnesses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gun Violence, mental health, and Connecticut physicians. Dodds, PR., Anderson, CO., Dodds, JH.[2015]

In a survey of 1,189 residents from low-income neighborhoods in New Haven, Connecticut, 73% reported hearing gunshots, and significant numbers had personal connections to gun violence, with 29% having family or friends harmed and 18% killed.

The study highlighted that exposure to gun violence is disproportionately higher among residents of color, particularly young Black men aged 18 to 34, emphasizing the need for a public health approach that addresses both mass shootings and urban violence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bridging the Response to Mass Shootings and Urban Violence: Exposure to Violence in New Haven, Connecticut. Santilli, A., O'Connor Duffany, K., Carroll-Scott, A., et al.[2022]

Community-led solutions, such as promoting role models and enhancing social cohesion, are essential for preventing gun violence in communities of color, as identified through interviews with 45 individuals in New Haven, CT.

Investing in stable housing, community-based mental health services, and youth activities can significantly help reduce the factors contributing to gun violence in these neighborhoods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"We know what's going on in our community": A qualitative analysis identifying community assets that deter gun violence. Parsons, A., Harvey, TD., Andrade, SD., et al.[2023]

Gun violence rates have increased during the COVID-19 pandemic due to factors like social isolation and economic instability, particularly affecting marginalized communities.

Hospital-based violence intervention programs (HVIPs) are essential for reducing repeat violent injuries, but the pandemic has created significant barriers to their effectiveness, necessitating adaptations in service delivery to better support participants.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring emergent barriers to hospital-based violence intervention programming during the COVID-19 pandemic. Wical, W., Harfouche, M., Lovelady, N., et al.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN): A strengths-based and community-driven stepped-wedge intervention to reduce gun violence. [2023]

2. England pubmed.ncbi.nlm.nih.gov

Trusted residents and housing assistance to decrease violence exposure in New Haven (TRUE HAVEN): a strengths-based and community-driven stepped-wedge intervention to reduce gun violence. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Identifying variability in permanent supportive housing: A comparative effectiveness approach to measuring health outcomes. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Safer neighborhoods? Violent crime and trauma volume pre/post targeted police interventions in Dallas, Texas. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Gun Violence, mental health, and Connecticut physicians. [2015]

8. United States pubmed.ncbi.nlm.nih.gov

Bridging the Response to Mass Shootings and Urban Violence: Exposure to Violence in New Haven, Connecticut. [2022]

9. England pubmed.ncbi.nlm.nih.gov

"We know what's going on in our community": A qualitative analysis identifying community assets that deter gun violence. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Exploring emergent barriers to hospital-based violence intervention programming during the COVID-19 pandemic. [2023]